New Majority has looked into why talk radio is getting even angrier and found it is because of pressures from a declining audience with talk radio having lost 30 to 40 percent of its ad revenue over the last two years:

In this environment, radio hosts believe that anger is their only path to survival. “If you’re not the most extreme person on the radio or making the most outrageous headlines,” says Fybush, “there is going to be some portion of the base that is going to ignore you and move onto someone who is more extreme.”

One of the most civil voices in talk radio, Michael Medved, explains the economic pressure upon the industry. He told NewMajority: “In this [economic] environment, you have something of a push to be outrageous, to be on the fringe, because what you’re desperately competing for is… P-1 listeners [those who tune in most frequently]. The percentage of people on the fringe who are P-1s is quite high,” he explained. As a result, talk radio hosts are feeling more pressure than usual to yell harder, scream louder, and insult further. Talk shows “are fighting for an ever- smaller pie, [which means that] you’ve got to be even louder about it because you’re trying to get the attention of an ever-smaller niche,” said Medved.

That goes along with the comments I’ve had here from time to time on talk radio suggesting that most of them are just putting on acts for the ratings and they don’t really believe the nonsense they say on the air.

There’s some more fact checking on health care reform worth noting today. The Los Angeles Times has a handful of questions. Their answers are longer, but I’ll just give the beginnings a portion of their answers:

Does the legislation include provisions to encourage senior citizens to commit suicide?

No. This has become one of the most misleading, inflammatory claims made in the healthcare debate, advanced repeatedly by conservative commentators such as Rush Limbaugh and Sean Hannity and Republican lawmakers working to stoke fears among seniors.

Rep. Virginia Foxx (R-N.C.) recently suggested that the Democratic healthcare bill would “put seniors in a position of being put to death by their government.” There is no such provision.

Would the government ration care?

This is almost impossible to say, although if the legislation passes there may be less “rationing” than there is now…

Most controversial, the bills would fund more research into the comparative effectiveness of various drugs and medical procedures.

The legislation does not dictate that the research be used to limit coverage of any procedures. And many doctors and other healthcare experts see this kind of research as crucial to improving the quality of care. Nonetheless, some critics say the provisions someday could allow the government to use this research to limit what Medicare or other government insurance programs would cover.

People such as scientist Stephen Hawking wouldn’t have a chance in the U.K., where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless.

Bookman notes the absurdity of using Hawking as an example:

Of course, that same Stephen Hawking who wouldn’t have a chance in the United Kingdom was in fact born in the United Kingdom, has lived his entire life in the United Kingdom and lives there still today, at the ripe old age of 67. (He was in fact hospitalized earlier this month.) Hawking is, you might say, living, breathing proof that these people are first-class fools.

Howard Kurtz has discussed the media’s coverage of Sarah Palin’s claims about death panels:

Yes, there is a point where the media should say a politician is wrong, and this is the point. There may or may not be a legitimate discussion about the end-of-life counseling in the Obama health plan (which is voluntary, by the way) and whether it is intrusive. It’s a long way from that to “death panels,” even by the loose rhetorical standards of modern politics. I was surprised that the ex-governor’s Facebook comments didn’t get much pickup at first, though that is starting to change in the last couple of days. As I noted in this morning’s column, wasn’t it Sarah Palin who demanded that journalists “quick making things up”?

Finally, if any other evidence is needed that there is nothing to the euthanasia claims, Glenn Beck has joined Sarah Palin and other ignorant right wingers in making this claim.

Calling those who protest against health care reform “Un-American” is not much better than calling them terrorists. Yes, I know they are spreading a lot of misinformation and otherwise misbehaving. We should be better than them and we must respect their right to protest.

And yes, many of those on the right who are upset are taking the comment out of context. It isn’t anywhere near as bad as actually used by Nancy Pelosi, but I’d still stay clear of such language. Her actual statement:

These disruptions are occurring because opponents are afraid not just of differing views — but of the facts themselves. Drowning out opposing views is simply un-American. Drowning out the facts is how we failed at this task for decades.

Health care is complex. It touches every American life. It drives our economy. People must be allowed to learn the facts.

Update: As I stated in the comments, It is not so much that I object to Pelosi’s actual statement but that I wouldn’t give the right even this amount of ammunition. When it becomes necessary to explain Pelosi’s statement this is just distracting more from the actual health care debate (which is probably what the people on the right want). She could have made her point while staying away from loaded words like “Un-American.” The fact that the right uses such language regularly does not mean that Democrats should.

I did not envision that we could get this far down the road toward fundamental health care reform with so little input in the public discourse from physicians. Sure, the AMA has come out in favor of the House bill that includes public option. But where are voices of individual docs whose front line experience with the impediments to delivering quality health care offer invaluable instruction?

My personal experience has been that there remains a strongly conservative core segment of physicians who are wary of reform for temperamental and financial reasons (not to paint with too broad a brush, but a group that is anchored in the high-dollar medical specialties). But I’ve seen over the last 20 years or so, an equally strong segment emerge from the physician ranks: primary care docs who struggle to reconcile the demands of the modern health care financial infrastructure with their calling to make people well (or better yet, keep them healthy).

So where are the family practice docs, the public health docs, the rural practitioners, those who staff the inner city clinics? I’m not suggesting they’re purposely sitting on the sidelines, but they do seem to have been sidelined in this debate. Can we hear more from them? Have I just missed it?

Apparently he is not reading this blog!

One factor is that, regardless of their views on health care reform, doctors tend to be busy. Not many of my colleagues have a RSS reader and a window open to the blogsphere open while also using the computer for work. More of them are more likely to spend their free time playing golf as opposed to getting involved in politics.

That does not mean there is not discussion of heath care reform. It is a hot topic in the medical journals. We know that Ann Althouse doesn’t know what she is talking about when she claims there is no problem. We see people with horror stories on a regular basis (and many more people are unable to see us due to lack of coverage). Those of us who are self-employed have also experienced the problems of purchasing insurance on the individual market or for small businesses.

Health care reform is also a hot topic in the medical journals. From time to time I’ve blogged about such articles here. The most recent such post was about an editorial in The American Journal of Medicine backing Medicare for all. In this instance many in the medical profession are to the left of the Democratic Party.

Jon Stewart is often, only half-jokingly, referred to as the most trusted anchorman today. Despite primarily being a comedian, he often does provide more information on important issues than the mainstream broadcast and cable media (a low bar to surpass). This includes information obtained from his interviews, especially with those who hold opposing viewpoints. New York Magazine has an article on Why Neoconservative Pundits Love Jon Stewart, initially quoting “Cliff May, a national-security hawk and former spokesman for the Republican Party.”

“There is genuine intellectual curiosity,” May told New York. “He’s a staunch liberal, but he’s a thoughtful liberal, and I respect that.” May isn’t the only conservative gushing about Stewart. While the movement professes a disdain for the “liberal media elite,” it has made an exception for the true-blue 46-year-old comedian. “He always gives you a chance to answer, which some people don’t do,” says John Bolton, President Bush’s ambassador to the United Nations and a Fox News contributor, who went on the show last month. “He’s got his perspective, but he’s been fair.” Says Bolton: “In general, a lot of the media, especially on the left, has lost interest in debate and analysis. It has been much more ad hominem. Stewart fundamentally wants to talk about the issues. That’s what I want to do.”

What’s more, Stewart seems to like hosting conservatives (Comedy Central did not reply to requests for comment). In recent weeks, Mike Huckabee, Newt Gingrich, and Bill Kristol have stopped by. Since the beginning of the Obama administration, Stewart has interviewed more conservative pundits than liberal ones. (Remember when fans fretted he’d have trouble finding ways to be funny under the new president?) It may be because it’s simply easier to tangle with an ideological adversary than to needle a compatriot. A clash of ideas is always more entertaining than an echo chamber. And, for a liberal wit like Stewart, it’s easier to stake out a clear position when facing off against a direct opponent. When he’s interviewing a liberal politician or pundit, he comes from a weaker position. His offensive instincts are blurred — notwithstanding his on-air indictment of Jim Cramer — and occasionally he fawns…

Conservatives like Stewart because he’s providing them a platform to reach an audience that usually tunes them out. And they often find that Stewart takes them more seriously than right-wing political hosts, who are often just using them to validate their broad positions, do. Stewart will poke fun, but he offers a good-faith debate on powder kegs — torture, abortion, nuclear weapons, health care — that explode on other networks. “Shepard Smith did the same discussion [on torture],” says May. “He kept yelling me at me: ‘This is where I get off the bus! Not in my name!’ He wasn’t arguing with me. It was just assertions and anger. That’s not what Jon deals in.”

I’m sure that to a considerable degree this is because of the differences between Jon Stewart and people like Bill O’Reily and Rush Limbaugh. More importantly, I think it is due to the differences between liberal and conservative audiences. The modern conservative movement has turned into a top-down movement where conservatives are more interested in having their biases reinforced. Liberals (as well as those conservatives who reject the conservative movement) are more interested in obtaining factual information.

This difference can be seen the most dramatically with radio. Conservative talk radio is thriving while comparatively few liberals listen to Air America. In contrast liberals tend to prefer the far more objective and informative NPR as opposed to more ideologically biased shows. On television MSNBC has only recently had some modest success with shows such as Keith Olbermann. One reason is that liberals have little choice on television. If we had a real cable news channel, as opposed to twenty-four coverage of headlines and often just one story of the day, I suspect that many liberals would choose that over the current MSNBC shows. Of course even these shows are generally far less shrill than their Fox counterparts, except when in direct battle with them. In interviewing conservatives to have a true exchange of ideas, Stewart is providing what a liberal audience wants.

Andrew Sullivan reponded to the post by David Frum which I discussed a couple of days ago. Sullivan agrees with Frum’s criticism of the standard conservative position arguing, “It was one thing to oppose greater government involvement in healthcare in 1993. It is another to do so in 2009.”

After further discussion of why we have no choice but to reform the health care system Sullivan concluded by chastising conservatives for preferring “a permanent populist culture-war” as opposed to proposing “actual solutions to pressing problems.”

If you have guaranteed emergency room care for the uninsured at public expense, you have already effectively socialized medicine. It makes no sense not to bring these people into the insurance system, and to offer less expensive, long-term preventive healthcare. To insist that ideology stand in the way of this piece of compassionate common sense is irresponsible.

I’ve come to accept that the fiscal and economic costs of the current system, however wonderful it has been for a few decades, simply cannot be sustained much longer. I say that not because I have become a socialist, but because the US is on the brink of the kind of bankruptcy it will be very hard to recover from if we do not tackle its source now. Taking measures to avoid fiscal collapse even greater than today’s is a conservative impulse. Letting one sector of the economy destroy the rest of it – and public finances too – is sheer recklessness.

What do you want, GOP? A permanent populist culture-war? Or actual solutions to pressing problems? Let us know when you’ve matured enough to answer that question.

I’ve discussed in several previous posts, such as here, reasons why preventive medicine will not result in sufficient cost savings to pay for expanding health care coverage. It takes many years to see any savings from preventive care and there are substantial costs associated with providing such care. The Congressional Budget Office has now released a report showing that preventive health care will raise rather than lower costs. It is a safe bet that conservatives will publicize this report, while they tended to ignore the recent report which showed that the proposed public plan would not lead to the destruction of private health insurance.

As with the earlier Congressional Budget Reports it is necessary to consider how they make their estimates. The costs of providing preventive care are concrete and will be included in their calculations. The benefits of preventive medicine cannot be easily measured and therefore will be underestimated by the procedures they use. In addition, many of the benefits of preventive medicine will not be seen for well over ten years and therefore will not be a factor in current cost/benefit calculations.

Providing preventive care will cost more than it will save in cases where the individual patient was not going to develop one of the diseases for which preventive care is being provided. In some cases successful preventive medicine might even increase costs further, such as if a person were to live many years longer and consume additional health care resources. In such cases preventive care provides a real benefit and should be paid for, but not because of cost savings.

There are other cases where preventive medicine will save money by reducing the need for expensive care. It is far more cost effective to treat diabetes and hypertension with regular follow up of these diseases than it is to pay for bypass surgery, dialysis, or post-stroke treatment. There is no way to accurately predict such savings and therefore they will be underestimated by the Congressional Budget Office.

Still the fact remains that expanding health care cannot be paid for with simple actions such as expanding preventive care or computerizing medical records. Preventive care, along with expanding health care to all, is of value and is something we should be paying for. It is unfortunate that we have an atmosphere in this country where politicians feel the need to downplay the costs of their programs because increasing taxes is no longer acceptable.

The Obama administration has downplayed the costs of their health care plans, but we saw the same under George Bush. In addition to having no plans for paying for his Medicare Part D program, Bush also threatened to fire experts from the Medicare program if they testified before Congress as to the actual cost. Nobody likes to pay taxes, but rather than having a knee jerk opposition to all taxes we must consider whether we are receiving value for what we are paying. Increasing preventive care will probably save some money in the long run, but the real benefit is being healthier and living longer. This is something worth paying for.